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Heart failure during cardiac pacing.

Michael O Sweeney1, Anne S Hellkamp

  • 1Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA. mosweeney@partners.org

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Summary
This summary is machine-generated.

Right ventricular apical pacing increases heart failure hospitalization risk, especially in patients with low ejection fraction or heart failure. Managing pacing modes and QRS duration is crucial for reducing this risk.

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Area of Science:

  • Cardiology
  • Electrophysiology
  • Medical Devices

Background:

  • Right ventricular apical (RVA) pacing can lead to abnormal left ventricular contraction, hypertrophy, and reduced pump function.
  • Ventricular desynchronization from RVA pacing is linked to increased heart failure hospitalization (HFH) risk.

Purpose of the Study:

  • To identify predictors of HFH in patients undergoing dual-chamber (DDDR) versus ventricular (VVIR) pacing.
  • To analyze the impact of baseline characteristics and pacing parameters on HFH risk.

Main Methods:

  • The Mode Selection Trial analyzed 2010 patients over 6 years, comparing DDDR and VVIR pacing.
  • Cox proportional hazards models were used to identify predictors of HFH, including New York Heart Association (NYHA) class, heart failure, atrioventricular (AV) block, myocardial infarction (MI), cumulative percent ventricular pacing (Cum%VP), and QRS duration (QRSd).

Main Results:

  • Baseline NYHA class, heart failure, AV block, and MI predicted HFH.
  • Postimplantation predictors included high VVIR Cum%VP (>80%), specific DDDR/VVIR Cum%VP thresholds, and paced versus spontaneous QRS duration.
  • Low ejection fraction (EF) and longer QRSd (especially when paced) were significant predictors, with risk increasing more steeply in patients with normal EF.

Conclusions:

  • HFH risk is influenced by the interaction between patient substrate (e.g., atrial fibrillation, heart failure, EF) and pacing parameters (e.g., QRSd, Cum%VP, pacing mode).
  • Effective management of RVA pacing is essential for mitigating HFH risk, particularly in vulnerable patient groups with low EF and existing heart failure.